HomeMy Public PortalAbout4863 ROBINHOOD AVE_Sewer__ APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING y
ADDRESS
JOHN A. Lr .AftB1E, COUNTY ENGINEER — - -_V-—
-
CASSATT D.GP.IF'FiN. SUP'If OF BUILDING LOCALITY °.6
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FOB. APPLICANT TO FILL IN doss�T.- �
`.._ BABA - --- -- ,-a• —_ _--- - __
LEGAL
OWNER
INTION LOT NO, - -
DESCR .✓ - r �, -` _---
_�' e - -
MAIL ;V
BLOCK TkAC'( d �;' +� t -+ --�-- ADDRESS
_., 0. .
S17E OF L07 ,s.., y E' _ NOW ON LOT OF BLDGCITY ,,,�:., TEL. NO..
USE OF
BUiL.D1NC,a. �-' .,y -.. -- — DISTRICT NO. ' GROUP` MAP
CONTRACTOR
ADDRESS CONNECTION DATA - – -
— .--
- ��
STATION ., DEPTH
CITY
140,O�
-:,t_- - MANHOLE REFERENCE _UPPER
— - STAT£
REGISTRATION NO, u COUNTY F- -
-- -,
Nd. DESCRIPTION! OF WORK FE - --- BABA—. -- --- -
._- -- -- -- BABA-- TYPE OF CONNECTIOX LENGTH FROM
MOUSE SEWER CONNECTING TO -- Y. CURB P L. N9 L TO P.L.
PUBLIC SEWER Cn1 $3.50 - --- -
---
SEPTIC TANK,SEEPAGE PIT OR
-PITSANIVOR DRAINFIELD C2' $3.00--
- - -- - --... BABA _- -... -r----'BABA--
OVERFLOW SEEPAGE PIT, DRAINFIELD P C. NO, i
EXTN.,CFSSPOOL,DRYVIELL,'>4ANHOLE ,z S 2.00 j CO. IMP.NO.
...—....------
iHOUSE SEWER CONNECTING TO -_-- — -
PRIVATE DISPOSAI. SYSTEM r 5.1.00 � v_---�—-_^ TRUNK PERMIT NO. ROAD PERMIT NO.
� --�—'--BABA-- -
CONNECT ADDITIONAL BLDG.OR j STATE ENCROACHMENT
WORK TO HOUSE SEW'ER fin. .00 ! I PERMIT NO.
..^ -..-_ ._ I i.
-..:...
ALTER,REPAIR OR 'ABANDON HOUSE - _--- _---
SEWED OR DISPOSAL SYSTEM (t $1.00 I 1NDUSTRIhI .
—._--.- --- __--_T _-- _----.--._ WASTF APPROVAL CHARGES
-.---j`-------___-.. --`-BABA--
1
CONNECTION CHARGE FEE
OWNER'S PERMIT $ ill 00 — —--— --- ----- --— - —_.
ri— REIMBURSEMENT FEE
AU MORIZATION TOxAL FEE 4 6.
I HAVE AT THIS DATE A CONTRACT WITH THE HERE-7, NAMED CON- APPROVALS DATE INSPECTOR'S SIGNAURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING � I
TO THE PUBLIC SEWER. N.EW HOUSE SEWER �- F
...el -y�•' .._.�_. -BABA-- -.- --_.:_.i
SIGNED THIS -DAY OF CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK I I
OWNERS AGENT v3 .. r --_..:-- BABA----------F _...--.�-.
, 'z --- SEPTIC TANK,SEEP,PIT(S)
ADDRESS__�. °�% AND/OR DRAINFIELD
' . µ- .- -- -- ,-,------BABA-- - --
I HEREBY ACKNOWLEDGE THAT I HAVE READ_ THIS APPLICATION CESSPOOL I.] DrtXWELL O
AND STATE THAT THE ABOVE IS CORRECT AND AGREE i0 COMPLY -.------_-_-.__---
`ttITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING ANS E 4'EPS, SEWAGE,DISPOSAL SYSTEM
-- c PLUG
1 HEREBY C'��i:SIFY THAT 7 AM PROPERLY REGISTERED AN Di OR DISCONNc,CT'T PLUG AND I T
LICENSED YAC REQUiREA'D BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT i E ABOVE -ABAND --' - I--- �-
� X39 1'I-E LEGAL OWNER OF 7H
DESCRIBED RESIDENT! IT FPOPE.R- - SACK:FILL SEPTIC TANKS-0
SIGNATURE v �11
SEEP.FI'T(S)Lj_CESSPOOLS El
OF PERMITTEE _ — -- --._—'
IOHN A. LANBIE, CrJUAyTY E1NGIrNFER 7 VAUDAlION ROBEIR i A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH